|
ARTERI VENOUS SHUNT
|
Facility
|
OP
|
$1,392.00
|
|
|
Service Code
|
HCPCS 36901
|
| Hospital Charge Code |
36000052
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$478.71 |
| Max. Negotiated Rate |
$2,009.49 |
| Rate for Payer: Aetna Commercial |
$1,071.84
|
| Rate for Payer: Anthem Medicaid |
$478.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,435.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,085.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,009.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,937.72
|
| Rate for Payer: Cash Price |
$696.00
|
| Rate for Payer: Cash Price |
$696.00
|
| Rate for Payer: Cigna Commercial |
$1,155.36
|
| Rate for Payer: First Health Commercial |
$1,322.40
|
| Rate for Payer: Humana Commercial |
$1,183.20
|
| Rate for Payer: Humana KY Medicaid |
$478.71
|
| Rate for Payer: Humana Medicare Advantage |
$1,435.35
|
| Rate for Payer: Kentucky WC Medicaid |
$483.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,141.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,027.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,722.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$488.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,224.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,044.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,113.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,211.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$960.48
|
| Rate for Payer: PHCS Commercial |
$1,336.32
|
| Rate for Payer: United Healthcare All Payer |
$1,224.96
|
|
|
ARTERI VENOUS SHUNT
|
Facility
|
OP
|
$1,483.00
|
|
|
Service Code
|
HCPCS 36901
|
| Hospital Charge Code |
48100032
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$510.00 |
| Max. Negotiated Rate |
$2,009.49 |
| Rate for Payer: Aetna Commercial |
$1,141.91
|
| Rate for Payer: Anthem Medicaid |
$510.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,435.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,156.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,009.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,937.72
|
| Rate for Payer: Cash Price |
$741.50
|
| Rate for Payer: Cash Price |
$741.50
|
| Rate for Payer: Cigna Commercial |
$1,230.89
|
| Rate for Payer: First Health Commercial |
$1,408.85
|
| Rate for Payer: Humana Commercial |
$1,260.55
|
| Rate for Payer: Humana KY Medicaid |
$510.00
|
| Rate for Payer: Humana Medicare Advantage |
$1,435.35
|
| Rate for Payer: Kentucky WC Medicaid |
$515.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,216.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,094.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,722.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$520.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,305.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,112.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,186.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,290.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,023.27
|
| Rate for Payer: PHCS Commercial |
$1,423.68
|
| Rate for Payer: United Healthcare All Payer |
$1,305.04
|
|
|
ARTERI VENOUS SHUNT
|
Facility
|
IP
|
$1,392.00
|
|
|
Service Code
|
HCPCS 36901
|
| Hospital Charge Code |
36000052
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$417.60 |
| Max. Negotiated Rate |
$1,336.32 |
| Rate for Payer: Aetna Commercial |
$1,071.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,085.76
|
| Rate for Payer: Cash Price |
$696.00
|
| Rate for Payer: Cigna Commercial |
$1,155.36
|
| Rate for Payer: First Health Commercial |
$1,322.40
|
| Rate for Payer: Humana Commercial |
$1,183.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,141.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,027.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$417.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,224.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,044.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,113.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,211.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$960.48
|
| Rate for Payer: PHCS Commercial |
$1,336.32
|
| Rate for Payer: United Healthcare All Payer |
$1,224.96
|
|
|
ARTERI VENOUS SHUNT
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
HCPCS 36901
|
| Hospital Charge Code |
76101514
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$154.75 |
| Max. Negotiated Rate |
$2,009.49 |
| Rate for Payer: Aetna Commercial |
$346.50
|
| Rate for Payer: Anthem Medicaid |
$154.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,435.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$351.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,009.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,937.72
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$373.50
|
| Rate for Payer: First Health Commercial |
$427.50
|
| Rate for Payer: Humana Commercial |
$382.50
|
| Rate for Payer: Humana KY Medicaid |
$154.75
|
| Rate for Payer: Humana Medicare Advantage |
$1,435.35
|
| Rate for Payer: Kentucky WC Medicaid |
$156.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$369.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$332.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,722.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$157.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$396.00
|
| Rate for Payer: Ohio Health Group HMO |
$337.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$391.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.50
|
| Rate for Payer: PHCS Commercial |
$432.00
|
| Rate for Payer: United Healthcare All Payer |
$396.00
|
|
|
ARTERI VENOUS SHUNT(P
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 36901
|
| Hospital Charge Code |
761P1514
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$124.62 |
| Max. Negotiated Rate |
$438.55 |
| Rate for Payer: Ambetter Exchange |
$157.30
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$124.62
|
| Rate for Payer: Anthem Medicaid |
$429.95
|
| Rate for Payer: Buckeye Individual/Medicaid |
$157.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$157.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$188.76
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$243.20
|
| Rate for Payer: Humana Medicaid |
$429.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$188.66
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$157.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$157.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$438.55
|
| Rate for Payer: Molina Healthcare Passport |
$429.95
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$204.49
|
| Rate for Payer: UHCCP Medicaid |
$130.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$434.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$157.30
|
|
|
ARTERY BYPASS GRAFT
|
Facility
|
IP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 35621
|
| Hospital Charge Code |
76101408
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$900.00 |
| Max. Negotiated Rate |
$2,880.00 |
| Rate for Payer: Aetna Commercial |
$2,310.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,340.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,490.00
|
| Rate for Payer: First Health Commercial |
$2,850.00
|
| Rate for Payer: Humana Commercial |
$2,550.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,460.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,214.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$900.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,610.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,070.00
|
| Rate for Payer: PHCS Commercial |
$2,880.00
|
| Rate for Payer: United Healthcare All Payer |
$2,640.00
|
|
|
ARTERY BYPASS GRAFT
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 35621
|
| Hospital Charge Code |
76101408
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$934.91 |
| Max. Negotiated Rate |
$1,964.95 |
| Rate for Payer: Aetna Commercial |
$1,964.95
|
| Rate for Payer: Ambetter Exchange |
$1,026.90
|
| Rate for Payer: Anthem Medicaid |
$934.91
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,026.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,026.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,232.28
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$1,883.40
|
| Rate for Payer: Healthspan PPO |
$1,931.93
|
| Rate for Payer: Humana Medicaid |
$934.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,517.65
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,026.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,026.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$953.61
|
| Rate for Payer: Molina Healthcare Passport |
$934.91
|
| Rate for Payer: Multiplan PHCS |
$1,800.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,334.97
|
| Rate for Payer: UHCCP Medicaid |
$1,050.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$944.26
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,026.90
|
|
|
ARTERY BYPASS GRAFT
|
Facility
|
IP
|
$3,300.00
|
|
|
Service Code
|
HCPCS 35666
|
| Hospital Charge Code |
76101414
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$990.00 |
| Max. Negotiated Rate |
$3,168.00 |
| Rate for Payer: Aetna Commercial |
$2,541.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,574.00
|
| Rate for Payer: Cash Price |
$1,650.00
|
| Rate for Payer: Cigna Commercial |
$2,739.00
|
| Rate for Payer: First Health Commercial |
$3,135.00
|
| Rate for Payer: Humana Commercial |
$2,805.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,706.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,435.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$990.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,904.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,475.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,871.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,277.00
|
| Rate for Payer: PHCS Commercial |
$3,168.00
|
| Rate for Payer: United Healthcare All Payer |
$2,904.00
|
|
|
ARTERY BYPASS GRAFT
|
Professional
|
Both
|
$3,200.00
|
|
|
Service Code
|
HCPCS 35556
|
| Hospital Charge Code |
76101396
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,045.93 |
| Max. Negotiated Rate |
$2,431.80 |
| Rate for Payer: Aetna Commercial |
$2,431.80
|
| Rate for Payer: Ambetter Exchange |
$1,306.10
|
| Rate for Payer: Anthem Medicaid |
$1,045.93
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,306.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,306.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,567.32
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cigna Commercial |
$2,297.28
|
| Rate for Payer: Healthspan PPO |
$2,390.93
|
| Rate for Payer: Humana Medicaid |
$1,045.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,921.35
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,306.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,306.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,066.85
|
| Rate for Payer: Molina Healthcare Passport |
$1,045.93
|
| Rate for Payer: Multiplan PHCS |
$1,920.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,697.93
|
| Rate for Payer: UHCCP Medicaid |
$1,120.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,056.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,306.10
|
|
|
ARTERY BYPASS GRAFT
|
Facility
|
OP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 35621
|
| Hospital Charge Code |
76101408
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$900.00 |
| Max. Negotiated Rate |
$2,880.00 |
| Rate for Payer: Aetna Commercial |
$2,310.00
|
| Rate for Payer: Anthem Medicaid |
$1,031.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,340.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,490.00
|
| Rate for Payer: First Health Commercial |
$2,850.00
|
| Rate for Payer: Humana Commercial |
$2,550.00
|
| Rate for Payer: Humana KY Medicaid |
$1,031.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,042.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,460.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,214.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$900.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,052.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,610.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,070.00
|
| Rate for Payer: PHCS Commercial |
$2,880.00
|
| Rate for Payer: United Healthcare All Payer |
$2,640.00
|
|
|
ARTERY BYPASS GRAFT
|
Facility
|
OP
|
$3,300.00
|
|
|
Service Code
|
HCPCS 35666
|
| Hospital Charge Code |
76101414
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$990.00 |
| Max. Negotiated Rate |
$3,168.00 |
| Rate for Payer: Aetna Commercial |
$2,541.00
|
| Rate for Payer: Anthem Medicaid |
$1,134.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,574.00
|
| Rate for Payer: Cash Price |
$1,650.00
|
| Rate for Payer: Cigna Commercial |
$2,739.00
|
| Rate for Payer: First Health Commercial |
$3,135.00
|
| Rate for Payer: Humana Commercial |
$2,805.00
|
| Rate for Payer: Humana KY Medicaid |
$1,134.87
|
| Rate for Payer: Kentucky WC Medicaid |
$1,146.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,706.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,435.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$990.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,157.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,904.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,475.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,871.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,277.00
|
| Rate for Payer: PHCS Commercial |
$3,168.00
|
| Rate for Payer: United Healthcare All Payer |
$2,904.00
|
|
|
ARTERY BYPASS GRAFT
|
Facility
|
IP
|
$3,200.00
|
|
|
Service Code
|
HCPCS 35556
|
| Hospital Charge Code |
76101396
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$960.00 |
| Max. Negotiated Rate |
$3,072.00 |
| Rate for Payer: Aetna Commercial |
$2,464.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,496.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cigna Commercial |
$2,656.00
|
| Rate for Payer: First Health Commercial |
$3,040.00
|
| Rate for Payer: Humana Commercial |
$2,720.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,624.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,361.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$960.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,816.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,400.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,784.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,208.00
|
| Rate for Payer: PHCS Commercial |
$3,072.00
|
| Rate for Payer: United Healthcare All Payer |
$2,816.00
|
|
|
ARTERY BYPASS GRAFT
|
Professional
|
Both
|
$3,300.00
|
|
|
Service Code
|
HCPCS 35666
|
| Hospital Charge Code |
76101414
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,103.86 |
| Max. Negotiated Rate |
$2,248.34 |
| Rate for Payer: Aetna Commercial |
$2,248.34
|
| Rate for Payer: Ambetter Exchange |
$1,200.83
|
| Rate for Payer: Anthem Medicaid |
$1,103.86
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,200.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,200.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,441.00
|
| Rate for Payer: Cash Price |
$1,650.00
|
| Rate for Payer: Cash Price |
$1,650.00
|
| Rate for Payer: Cigna Commercial |
$2,161.54
|
| Rate for Payer: Healthspan PPO |
$2,210.56
|
| Rate for Payer: Humana Medicaid |
$1,103.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,748.12
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,200.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,200.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,125.94
|
| Rate for Payer: Molina Healthcare Passport |
$1,103.86
|
| Rate for Payer: Multiplan PHCS |
$1,980.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,561.08
|
| Rate for Payer: UHCCP Medicaid |
$1,155.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,114.90
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,200.83
|
|
|
ARTERY BYPASS GRAFT
|
Facility
|
OP
|
$3,200.00
|
|
|
Service Code
|
HCPCS 35556
|
| Hospital Charge Code |
76101396
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$960.00 |
| Max. Negotiated Rate |
$3,072.00 |
| Rate for Payer: Aetna Commercial |
$2,464.00
|
| Rate for Payer: Anthem Medicaid |
$1,100.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,496.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cigna Commercial |
$2,656.00
|
| Rate for Payer: First Health Commercial |
$3,040.00
|
| Rate for Payer: Humana Commercial |
$2,720.00
|
| Rate for Payer: Humana KY Medicaid |
$1,100.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,111.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,624.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,361.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$960.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,122.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,816.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,400.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,784.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,208.00
|
| Rate for Payer: PHCS Commercial |
$3,072.00
|
| Rate for Payer: United Healthcare All Payer |
$2,816.00
|
|
|
ARTERY BYPASS GRAFT(P
|
Professional
|
Both
|
$3,200.00
|
|
|
Service Code
|
HCPCS 35556
|
| Hospital Charge Code |
761P1396
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,045.93 |
| Max. Negotiated Rate |
$2,431.80 |
| Rate for Payer: Aetna Commercial |
$2,431.80
|
| Rate for Payer: Ambetter Exchange |
$1,306.10
|
| Rate for Payer: Anthem Medicaid |
$1,045.93
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,306.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,306.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,567.32
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cigna Commercial |
$2,297.28
|
| Rate for Payer: Healthspan PPO |
$2,390.93
|
| Rate for Payer: Humana Medicaid |
$1,045.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,921.35
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,306.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,306.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,066.85
|
| Rate for Payer: Molina Healthcare Passport |
$1,045.93
|
| Rate for Payer: Multiplan PHCS |
$1,920.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,697.93
|
| Rate for Payer: UHCCP Medicaid |
$1,120.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,056.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,306.10
|
|
|
ARTERY BYPASS GRAFT(P
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 35621
|
| Hospital Charge Code |
761P1408
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$934.91 |
| Max. Negotiated Rate |
$1,964.95 |
| Rate for Payer: Aetna Commercial |
$1,964.95
|
| Rate for Payer: Ambetter Exchange |
$1,026.90
|
| Rate for Payer: Anthem Medicaid |
$934.91
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,026.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,026.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,232.28
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$1,883.40
|
| Rate for Payer: Healthspan PPO |
$1,931.93
|
| Rate for Payer: Humana Medicaid |
$934.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,517.65
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,026.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,026.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$953.61
|
| Rate for Payer: Molina Healthcare Passport |
$934.91
|
| Rate for Payer: Multiplan PHCS |
$1,800.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,334.97
|
| Rate for Payer: UHCCP Medicaid |
$1,050.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$944.26
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,026.90
|
|
|
ARTERY BYPASS GRAFT(P
|
Professional
|
Both
|
$3,300.00
|
|
|
Service Code
|
HCPCS 35666
|
| Hospital Charge Code |
761P1414
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,103.86 |
| Max. Negotiated Rate |
$2,248.34 |
| Rate for Payer: Aetna Commercial |
$2,248.34
|
| Rate for Payer: Ambetter Exchange |
$1,200.83
|
| Rate for Payer: Anthem Medicaid |
$1,103.86
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,200.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,200.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,441.00
|
| Rate for Payer: Cash Price |
$1,650.00
|
| Rate for Payer: Cash Price |
$1,650.00
|
| Rate for Payer: Cigna Commercial |
$2,161.54
|
| Rate for Payer: Healthspan PPO |
$2,210.56
|
| Rate for Payer: Humana Medicaid |
$1,103.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,748.12
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,200.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,200.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,125.94
|
| Rate for Payer: Molina Healthcare Passport |
$1,103.86
|
| Rate for Payer: Multiplan PHCS |
$1,980.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,561.08
|
| Rate for Payer: UHCCP Medicaid |
$1,155.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,114.90
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,200.83
|
|
|
ARTERY X-RAYS LUNG
|
Professional
|
Both
|
$4,885.00
|
|
|
Service Code
|
HCPCS 75741
|
| Hospital Charge Code |
32000160
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$83.98 |
| Max. Negotiated Rate |
$2,931.00 |
| Rate for Payer: Aetna Commercial |
$429.07
|
| Rate for Payer: Ambetter Exchange |
$118.21
|
| Rate for Payer: Anthem Medicaid |
$396.54
|
| Rate for Payer: Buckeye Individual/Medicaid |
$118.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$118.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$141.85
|
| Rate for Payer: Cash Price |
$2,442.50
|
| Rate for Payer: Cash Price |
$2,442.50
|
| Rate for Payer: Cigna Commercial |
$690.01
|
| Rate for Payer: Healthspan PPO |
$402.05
|
| Rate for Payer: Humana Medicaid |
$396.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$83.98
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$118.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$118.21
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$404.47
|
| Rate for Payer: Molina Healthcare Passport |
$396.54
|
| Rate for Payer: Multiplan PHCS |
$2,931.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$153.67
|
| Rate for Payer: UHCCP Medicaid |
$1,709.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$400.51
|
| Rate for Payer: Wellcare Medicare Advantage |
$118.21
|
|
|
ARTERY X-RAYS LUNG
|
Facility
|
IP
|
$4,885.00
|
|
|
Service Code
|
HCPCS 75741
|
| Hospital Charge Code |
32000160
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,465.50 |
| Max. Negotiated Rate |
$4,689.60 |
| Rate for Payer: Aetna Commercial |
$3,761.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,810.30
|
| Rate for Payer: Cash Price |
$2,442.50
|
| Rate for Payer: Cigna Commercial |
$4,054.55
|
| Rate for Payer: First Health Commercial |
$4,640.75
|
| Rate for Payer: Humana Commercial |
$4,152.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,005.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,605.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,465.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,298.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,663.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,908.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,249.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,370.65
|
| Rate for Payer: PHCS Commercial |
$4,689.60
|
| Rate for Payer: United Healthcare All Payer |
$4,298.80
|
|
|
ARTERY X-RAYS LUNG
|
Professional
|
Both
|
$3,056.00
|
|
|
Service Code
|
HCPCS 75746
|
| Hospital Charge Code |
32000284
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$73.16 |
| Max. Negotiated Rate |
$1,833.60 |
| Rate for Payer: Aetna Commercial |
$431.92
|
| Rate for Payer: Ambetter Exchange |
$122.94
|
| Rate for Payer: Anthem Medicaid |
$389.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$122.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$122.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$147.53
|
| Rate for Payer: Cash Price |
$1,528.00
|
| Rate for Payer: Cash Price |
$1,528.00
|
| Rate for Payer: Cigna Commercial |
$682.80
|
| Rate for Payer: Healthspan PPO |
$404.71
|
| Rate for Payer: Humana Medicaid |
$389.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$73.16
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$122.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$122.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$396.94
|
| Rate for Payer: Molina Healthcare Passport |
$389.16
|
| Rate for Payer: Multiplan PHCS |
$1,833.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$159.82
|
| Rate for Payer: UHCCP Medicaid |
$1,069.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$393.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$122.94
|
|
|
ARTERY X-RAYS LUNG
|
Facility
|
OP
|
$3,056.00
|
|
|
Service Code
|
HCPCS 75746
|
| Hospital Charge Code |
32000284
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,050.96 |
| Max. Negotiated Rate |
$4,071.52 |
| Rate for Payer: Aetna Commercial |
$2,353.12
|
| Rate for Payer: Anthem Medicaid |
$1,050.96
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,383.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| Rate for Payer: Cash Price |
$1,528.00
|
| Rate for Payer: Cash Price |
$1,528.00
|
| Rate for Payer: Cigna Commercial |
$2,536.48
|
| Rate for Payer: First Health Commercial |
$2,903.20
|
| Rate for Payer: Humana Commercial |
$2,597.60
|
| Rate for Payer: Humana KY Medicaid |
$1,050.96
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,061.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,505.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,255.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,072.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,689.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,292.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,444.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,658.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,108.64
|
| Rate for Payer: PHCS Commercial |
$2,933.76
|
| Rate for Payer: United Healthcare All Payer |
$2,689.28
|
|
|
ARTERY X-RAYS LUNG
|
Facility
|
OP
|
$4,885.00
|
|
|
Service Code
|
HCPCS 75741
|
| Hospital Charge Code |
32000160
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,679.95 |
| Max. Negotiated Rate |
$4,689.60 |
| Rate for Payer: Aetna Commercial |
$3,761.45
|
| Rate for Payer: Anthem Medicaid |
$1,679.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,810.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| Rate for Payer: Cash Price |
$2,442.50
|
| Rate for Payer: Cash Price |
$2,442.50
|
| Rate for Payer: Cigna Commercial |
$4,054.55
|
| Rate for Payer: First Health Commercial |
$4,640.75
|
| Rate for Payer: Humana Commercial |
$4,152.25
|
| Rate for Payer: Humana KY Medicaid |
$1,679.95
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,697.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,005.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,605.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,713.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,298.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,663.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,908.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,249.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,370.65
|
| Rate for Payer: PHCS Commercial |
$4,689.60
|
| Rate for Payer: United Healthcare All Payer |
$4,298.80
|
|
|
ARTERY X-RAYS LUNG
|
Facility
|
IP
|
$3,056.00
|
|
|
Service Code
|
HCPCS 75746
|
| Hospital Charge Code |
32000284
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$916.80 |
| Max. Negotiated Rate |
$2,933.76 |
| Rate for Payer: Aetna Commercial |
$2,353.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,383.68
|
| Rate for Payer: Cash Price |
$1,528.00
|
| Rate for Payer: Cigna Commercial |
$2,536.48
|
| Rate for Payer: First Health Commercial |
$2,903.20
|
| Rate for Payer: Humana Commercial |
$2,597.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,505.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,255.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$916.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,689.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,292.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,444.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,658.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,108.64
|
| Rate for Payer: PHCS Commercial |
$2,933.76
|
| Rate for Payer: United Healthcare All Payer |
$2,689.28
|
|
|
ARTERY X-RAYS LUNG(P
|
Professional
|
Both
|
$256.00
|
|
|
Service Code
|
HCPCS 75746
|
| Hospital Charge Code |
320P0284
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$73.16 |
| Max. Negotiated Rate |
$682.80 |
| Rate for Payer: Aetna Commercial |
$431.92
|
| Rate for Payer: Ambetter Exchange |
$122.94
|
| Rate for Payer: Anthem Medicaid |
$389.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$122.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$122.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$147.53
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cigna Commercial |
$682.80
|
| Rate for Payer: Healthspan PPO |
$404.71
|
| Rate for Payer: Humana Medicaid |
$389.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$73.16
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$122.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$122.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$396.94
|
| Rate for Payer: Molina Healthcare Passport |
$389.16
|
| Rate for Payer: Multiplan PHCS |
$153.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$159.82
|
| Rate for Payer: UHCCP Medicaid |
$89.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$393.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$122.94
|
|
|
ARTERY X-RAYS LUNG(P
|
Professional
|
Both
|
$265.00
|
|
|
Service Code
|
HCPCS 75741
|
| Hospital Charge Code |
320P0160
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$83.98 |
| Max. Negotiated Rate |
$690.01 |
| Rate for Payer: Aetna Commercial |
$429.07
|
| Rate for Payer: Ambetter Exchange |
$118.21
|
| Rate for Payer: Anthem Medicaid |
$396.54
|
| Rate for Payer: Buckeye Individual/Medicaid |
$118.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$118.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$141.85
|
| Rate for Payer: Cash Price |
$132.50
|
| Rate for Payer: Cash Price |
$132.50
|
| Rate for Payer: Cigna Commercial |
$690.01
|
| Rate for Payer: Healthspan PPO |
$402.05
|
| Rate for Payer: Humana Medicaid |
$396.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$83.98
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$118.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$118.21
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$404.47
|
| Rate for Payer: Molina Healthcare Passport |
$396.54
|
| Rate for Payer: Multiplan PHCS |
$159.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$153.67
|
| Rate for Payer: UHCCP Medicaid |
$92.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$400.51
|
| Rate for Payer: Wellcare Medicare Advantage |
$118.21
|
|
